Reading of the Week: Stigmatizing Language & Patient Records – a New Qualitative Analysis; Also, Dr. Termini on Her Lie by Omission (JAMA)

From the Editor

After the hospitalization ends, a detailed summary. A quick note outlining the psychotherapy session. Written comments about the patient’s care as she or he begins work with another clinician. Medical records include all of the above.

But do they also include stigmatizing language?

In this week’s first selection, the authors consider such language in a new paper for JAMA Network Open. Jenny Park (of Oregon Health and Science University) and her co-authors look at 600 notes, and find the categories of positive and negative language using a qualitative analysis. They write: “Language has a powerful role in influencing subsequent clinician attitudes and behavior. Attention to this language could have a large influence on the promotion of respect and reduction of disparities for disadvantaged groups.”

 1024px-edwin_smith_papyrus_v2Ancient Egyptian medical records – stigmatizing language then too?

In our other selection, Dr. Katherine A. Termini (of Vanderbilt University) writes about self-disclosure. In a very personal essay, the psychiatrist discusses her own mental health problems – and her decision not to tell others in the medical profession. She then writes about changing her mind. “I encourage you to ask yourself: How have I contributed to this stigma and what can I do about it? If physicians step forward to tell their personal experiences with mental illness to an audience of colleagues willing to listen empathetically, we can make progress on the arduous task of destigmatizing mental health.”

DG

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Reading of the Week: Alcohol – with Papers from Lancet Oncology and CJP, and Coverage from NYT

From the Editor

This week, we focus on alcohol, with two papers and a news article. Obviously, alcohol isn’t new – distilling probably started in the 13th century – but the three selections offer fresh and important information that is clinically relevant.

In the first selection, we consider the link to cancer. In a new Lancet Oncology paper, Harriet Rumgay (of the International Agency for Research on Cancer) and her co-authors conduct a population-based study. “Globally, about 741 000, or 4.1%, of all new cases of cancer in 2020 were attributable to alcohol consumption.” We review the big paper and mull its clinical implications.

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In the second selection, Dr. Daniel Myran (of the University of Ottawa) and his co-authors look at ED visits due to alcohol. Drawing on administrative data, they write: “We found that that current patterns and temporal trends in ED visits due to alcohol show large disparities between urban and rural regions of Canada and by socioeconomic status.”

And in the third selection, reporter Anahad O’Connor writes about alcohol use disorder for The New York Times. In this highly readable article, he focuses on the struggles of a retired manager: “But this past winter, with the stress of the pandemic increasingly weighing on him, he found himself craving beer every morning, drinking in his car and polishing off two liters of Scotch a week.” O’Connor writes about several resources that may be helpful to patients and their families.

DG

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Reading of the Week: Canada Day – With Papers on Cannabis, Chatbots, Depression, Nutraceuticals and Benzodiazepines in Pregnancy

From the Editor

It’s Canada Day.

Let’s start by noting that not everyone has a day off. Some of our colleagues are working – perhaps in hospitals or vaccine clinics. A quick word of thanks to them for helping our patients on a holiday.

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Appropriately, this week’s selections will focus on Canadian work.

What makes a paper “Canadian” for the purposes of this review? That is, how do we define Canadian? Things could get complicated quickly when considering journal papers. Does the second author order “double double” at Tim Hortons? Has the senior author eaten poutine for breakfast? Is the journal’s action editor hoping that the Canadiens bring the Cup home?

Let’s keep things simple: all the papers selected this week have been published in a Canadian journal and the papers are clinically relevant for those of us seeing patients in Canada.

There are many papers that could have been chosen, of course. I’ve picked five papers – a mix of papers that have been featured previously in past Readings, and some new ones. All but one of the selected papers are recent.

Please note that there will be no Readings for the next two weeks.

DG

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Reading of the Week: Shamiri Layperson-Provided Therapy in Kenya – Big Study, But Ethical? Also, a Reader Comments on Chatbots

From the Editor 

There are more psychiatrists of African origin in the US than in the whole of Africa. And I could actually say similar examples from the Philippines, or India, or many other countries. There is an enormous shortage of mental health resources…” 

So comments Dr. Vikram Patel (of Harvard University). Across low-income nations, mental health care services are profoundly difficult to access. Could Shamir (Kiswahili for thrive) – an intervention built on simple psychological concepts and delivered by laypersons – be part of the solution? 

This week, we look at a new paper from JAMA PsychiatryTom L.  Osborn (of Kenya’s Shamiri Institute) and his co-authors describe the results of a study involving adolescents with depression and anxiety symptoms. To our knowledge, this is one of the first adequately powered tests in this population of a scalable intervention grounded in simple positive psychological elements.” We look at the big paper. 

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 But is the work ethical? In our second selection, we consider the editorial that accompanies the Osborn et al. paper. JAMA Psychiatry Editor Dr. Dost  Öngür (of Harvard University) defends the study and his decision to publish it: “Because this trial was already conducted, we considered the obligations of the journal to be different than those of investigators and prospective reviewers. The question for us was whether there is a benefit to society by publishing the study as it was conducted.” 

Finally, in our third selection, a reader writes us. Giorgio A.Tasca (of the University of Ottawa) responds to The New York Times article by Karen Brown considering chatbots. “Is scaling up an intervention with dubious research support – that results in low adherence and high dropout (and perhaps more demoralization as a result) – worth it?” 

Please note that there will be no Reading next week. 

DG  Continue reading

Reading of the Week: Suicide and Schizophrenia – Across Life Span; Also, Transgender-Inclusive Care (QT), and the NYT on Chatbots

From the Editor

This week, we have three selections.

In the first, we consider suicide and schizophrenia. In a new JAMA Psychiatry paper, Dr. Mark Olfson (of Columbia University) and his co-authors do a cohort study across life-span, tapping a massive database. They find: “the risk of suicide was higher compared with the general US population and was highest among those aged 18 to 34 years and lowest among those 65 years and older.” The authors see clear clinical implications: “These findings suggest that suicide prevention efforts for individuals with schizophrenia should include a focus on younger adults with suicidal symptoms and substance use disorders.”

In the second selection, we consider transgender-inclusive care, looking at a new Quick Takes podcast. Drs. June Lam and Alex Abramovich (both of the University of Toronto) comment on caring for members of this population. “Trans individuals are medically underserved and experience, poor mental health outcomes, high rates of disease burden – compared to cisgender individuals.”

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Finally, in our third selection from The New York Times, reporter Karen Brown writes about chatbots for psychotherapy, focusing on Woebot. The writer quotes psychologist Alison Darcy about the potential of these conversational agents: “If we can deliver some of the things that the human can deliver, then we actually can create something that’s truly scalable, that has the capability to reduce the incidence of suffering in the population.”

DG

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Reading of the Week: Suicide and Gender in Canada; Also, Access and Immigrants (CJP), and Chok on Variations on a Theme (CMAJ)

From the Editor

This week, we have three selections; all are from Canadian publications.

Suicide rates have been declining in this country. In the first selection, Sara Zulyniak (of the University of Calgary) and her co-authors look at suicide by age and gender, drawing on almost two decades’ worth of data. In their analysis, there is a surprising finding: “The suicide rates in females aged 10 to 19 and 20 to 29 were increasing between 2000 and 2018. In comparison, no male regression results indicated significantly increasing rates.” This research letter, just published in The Canadian Journal of Psychiatry, is short and relevant.

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In the second selection, also from The Canadian Journal of Psychiatry, Joanna Marie B. Rivera (of Simon Fraser University) and her co-authors consider access to care. They focus on immigrants and nonimmigrants, noting differences in the way care is provided for those with mood disorders. “People with access to team-based primary care are more likely to report mental health consultations, and this is especially true for immigrants. Unfortunately, immigrants, and especially recent immigrants, are more likely to see a doctor in solo practice or use walk-in clinics as a usual place of care.”

Finally, in our third selection from CMAJ, Dr. Rozalyn Chok (of the University of Alberta), a pianist who is now a resident of paediatrics, describes a performance at a mental hospital. “I still hear exactly how it sounded on that tinny upright piano. I feel the uneven weighting of the keys, remember how difficult it was to achieve the voicing – the balance of melody and harmony – I wanted.” She reflects on the piece she played, and its impact on a patient.

DG

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Reading of the Week: Zen vs Zoloft for Relapse Prevention – the New JAMA Psych Paper; Also, Grossman-Kahn on Her Patient’s Cause (NEJM)

From the Editor

He feels better and he wants to go off medications, what should you recommend?

Patients raise this question often in depression management. For some, antidepressants are rich in side effects; others simply dislike the idea of long-term medications. For years, the response was simple: outline the risks of going off medications. Depression guidelines, after all, mention the need for continued antidepressants, especially for those who have had multiple past episodes. But, more recently, several papers have suggested that certain psychotherapies reduce the risk of relapse and can rival antidepressants.

But, until now, there hasn’t been a good meta-analysis. This week, in our first selection, we consider a new JAMA Psychiatry paper. Josefien J. F. Breedvelt (of the University of Amsterdam) and co-authors do an individual data meta-analysis comparing antidepressants and psychotherapies for relapse prevention – Zen versus Zoloft, if you will. They write: “The sequential delivery of a psychological intervention during and/or after tapering may be an effective relapse prevention strategy instead of long-term use of antidepressants.” We consider the big paper and its clinical implications.

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And in the second selection, Dr. Rebecca Grossman-Kahn (of the University of Minnesota) writes about a patient encounter in Minneapolis after the murder of George Floyd. Noting his manic episode, she wonders about larger questions, including diagnosis and coercion. This resident of psychiatry writes: “Training has taught me to recognize the signs of mania and psychosis. But nothing prepared me to ask courageous protesters to put their crucial work for change on hold due to mental illness.”

DG

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Reading of the Week: Helping Healthcare Workers Seek Help; Also, Smoking Cessation for Inpatients & Priebe on Why Patients Should Be Called Patients

From the Editor

How do we connect with them?

With the worst of the third wave now behind us, we are beginning to look forward. But for some, the problems of the pandemic aren’t fading. They will continue to struggle with mental health problems.

Healthcare workers are particularly at risk. They are also, collectively, a group that is difficult to engage. In the first selection, we look at a new paper from The British Journal of Psychiatry. Dr. Doron Amsalem (of Columbia University) and his co-authors do a video intervention to increase treatment seeking. The resulting RCT is impressive. The authors write: “The high proportion of healthcare workers surveyed in this study who reported symptoms of probable generalised anxiety, depression and/or PTSD emphasises the need for intervention aimed at increasing treatment-seeking among US healthcare workers. A three-minute online social contact-based video intervention effectively increased self-reported treatment-seeking intentions among healthcare workers.”

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In the second selection, Richard A. Brown (of the University of Texas at Austin) and his co-authors look at a new approach to an old problem: high smoking rates among people with severe mental illness. Focusing on inpatient hospitalizations, they design an intervention built on motivational interviewing. We consider their JAMA Psychiatry paper.

Is the term patient antiquated? Should we use other terms, like client or service user? In a BJPsych Bulletin paper, Dr. Stefan Priebe (of Queen Mary University of London) argues that we serve patients – and that words matter. “Mental healthcare is based on shared values and scientific evidence. Both require precise thinking, and precise thinking requires an exact and consistent terminology.”

DG

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Reading of the Week: How Has Mental Health Changed Over COVID? Also, Goldbloom on Practice & the Pandemic (Globe) and a Reader Responds to Psilocybin

From the Editor

Even our language has changed. Last winter, we didn’t think about lockdowns and the term social distancing was confined to sociology textbooks. The world is different.

And in our new reality, we can ask: How has the pandemic affected mental health? While there have been many small surveys (and much speculation), until now we have lacked a major, large scale survey.

This week, we look at a new paper from The Lancet Psychiatry. Matthias Pierce (of the University of Manchester) and his co-authors draw on the UK Household Longitudinal Study – a large, national survey that offers us pandemic and pre-pandemic data. The good news: “Between April and October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels…” but they also found that one in nine people in the UK “had deteriorating or consistently poor mental health.” We consider the big study and discuss resilience with an essay by Dr. Richard A. Friedman (of Cornell University).

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In the second selection, we consider an essay by Dr. David Goldbloom (of the University of Toronto) on how the pandemic has changed psychiatry. He focuses on the biggest change: that is, the embrace of virtual care. He begins: “We are all telepsychiatrists now…” He notes the advantages and disadvantages of the transformation. While some providers express ambivalence, he writes: “What counts, ultimately, is what helps our patients.”

Finally, a reader responds to our take on The New England Journal of Medicine paper on psilocybin. Dr. Craig P. Stewart (of Western University) writes: “One area I did not see mentioned in the psilocybin paper review was a discussion of confirmation bias, which I believe also should be mentioned to contextualize the results.”

DG

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Reading of the Week: How Will Venture Capital Change Psychiatry? Also, Gambling in Canada (CJP) and Dr. Bagley on Her Anxiety (JAMA)

From the Editor

Recently, one of patients raved about an app that she started to use. Talkspace offers her access to psychotherapy, unbound by geography, with a variety of therapist options.

The catch: she’s paying for it. In her opinion, it’s a good investment in her mental health. In Wall Street’s opinion, it’s a good investment in their financial health: that app has raised more than $110 million (USD) in venture capital. Other popular apps have also caught the eye and the backing of Wall Street – think Calm ($144 million USD) and Headspace ($167 million USD).

Is venture capital changing mental health care? And what are the potential problems? In the first selection, we consider a new Viewpoint paper by Drs. Ravi N. Shah (of Columbia University) and Obianuju O. Berry (of New York University). They write: “Although the value of this trend is yet to be fully realized, the rise in venture capital investment in mental health care offers an opportunity to scale treatments that work and address mental illness at the population level. However, quality control, privacy concerns, and severe mental illness are major issues that need to be addressed.”

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In our second selection, we look at a new paper by Robert J. Williams (of the University of Lethbridge) and his co-authors on gambling and problem gambling in Canada. Drawing on survey data, they find a surprising result: “Gambling and problem gambling have both decreased in Canada from 2002 to 2018 although the provincial patterns are quite similar between the 2 time periods.”

Finally, in our third selection, Dr. Sarah M. Bagley (of Boston University) discusses the problems of a newborn baby and its impact on his mother. The pediatrician isn’t writing about anyone – she is writing about her own experiences, and the resulting anxiety she experienced. “My story continues, but I hope that by sharing the issue of postpartum health can be better addressed among my colleagues and patients.”

DG

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